Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60453955 | WA |
NPI | 1720743750 |
---|---|
Provider Name | James Lucas Anderson |
First Address | Bellingham, WA 98229-7882 |
Second Address | Bellingham, WA 98229-7882 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2021 |
Last Update Date | 04/11/2021 |